Surgical Start Time Reliability: A Study in Improving Profit and Customer Satisfaction

CLIENT INDUSTRY: Healthcare

SOLUTION: Operational Excellence

After listening to patients and their loved ones’ complaints of having to wait well past their scheduled surgery times and considering the hospital’s rising overtime costs, Salina Regional Health Center leveraged their Lean Six Sigma training, the nurses, the managers and the entire surgical unit to help solve both problems.  Using proven problem-solving tools, the surgical team identified the main causes of delays and implemented countermeasures that significantly improved both issues.

The Challenge

Salina Regional Health Center’s surgical unit was experiencing increases in costs, particularly overtime premiums, due to surgical start time delays.  Just like when traveling, when the first flight leg is late, it is next to impossible to make up that time.  Management was facing tough decisions:  Should they schedule fewer surgeries per day to allow for “make-up time” between surgeries? Should they consider alternative work schedules? How should they absorb the additional costs?  Everyone recognized that reducing surgeries was an unacceptable option, so the leadership team decided to use Lean Six Sigma principles to help solve the problem.

“Understanding the problem’s root cause was the key first step in solving it.”
—Brian Weisel, Director Quality Improvement/Lean

The Approach

When things are not working as anticipated, many organizations respond by writing a new policy or procedure, training everyone and assuming the problem is solved. Another typical response might be calling a departmental meeting to explain what is happening and then demand people work together to fix it.  Prior to establishing an effective Lean Six Sigma training program, Salina Regional Health Center probably would have fallen into one of these same traps. Instead, when confronted with the challenge of rising surgery department overtime costs and increasing patient and family complaints due to delayed surgeries, Joel Phelps , President and CEO (COO at the time of this event), leveraged the team’s problem-solving training and Lean Six Sigma program to find viable solutions.

A team of surgical department employees who had been through Salina Regional Health Center’s Lean Six Sigma program, volunteered to execute this project.  The first order of business was to determine the real cause of the late surgical starts.  The team developed a pareto chart that captured reasons for these delays.  Tracking this data for a few weeks, the team concluded that the largest cause of late starts was not completing the patient history and physical (H&P) review on time.  They determined that every time the H&P was not done 25 minutes before the scheduled surgery start time, they were guaranteed to be behind schedule on that surgery and subsequent surgeries.   The team quickly realized that this really wasn’t the root cause but more of a symptom of their problem, so they dug deeper and discovered that the real cause was physicians not showing up on time for the 7:05AM patient H&P review.  (We will not get into how they solved this issue, but suffice it to say, the team worked together creatively and collectively to figure out how to improve this issue.)

After improving the largest issues identified in the pareto chart, the on-time to schedule reliability rate moved from 37% to 45%.  Not earth shattering, but it was a solid start nonetheless.  The team promptly understood that like most complex issues, there is never a quick fix.  While working their real full-time jobs, the team stayed focused on this problem and continued to resolve issues one-by-one in a prioritized way.  Currently the surgery department and team have been performing at a reliability rate of 85% on-time to schedule.

“Getting our costs better in line is a good thing, but not making our patients wait unnecessarily—that is where the real benefit was.”  Joel Phelps– President/CEO SHRC

Statistical Results

• The Reliability Rate rose from 37% to 85% on-time to schedule.
• Unplanned overtime in the surgical department was significantly reduced.
• Customer complaints decreased by 74% when examining the pre-surgical process.

Conclusion

Like most complex issues, there simply is not one quick fix that solves the problem.  In this case, the team was given the training, tools, time and coaching to define the problem, determine the causes of misses and implement countermeasures that ultimately drove significant and lasting improvement.  The improvement can be measured at both the P&L level as well as in patient satisfaction scores.  Projects do not get more meaningful than this!

About Competitive Business Solutions

Competitive Business Solutions consultants are masters of world-class operating and lean sigma principles. Creative problem-solvers throughout the improvement process—from initial discovery and strategic solution development to implementation and knowledge transfer—CBS consultants take pride in their client relationships, working side-by-side with every member of onsite teams to identify performance issues quickly and effectively, with significant and sustainable business improvement as a result.

About Salina Regional Health Center

Salina Regional Health Center Enterprises (SRHE) is a full-service acute care hospital licensed for 373 beds.  It has almost 2,000 employees and a medical staff of 127 physicians, of which 67 physicians are employed by the hospital.  The hospital has invested millions to hire the most capable medical professionals and acquire the most advanced technologies and treatments, all supporting their many comprehensive medical specialties and clinics.  Salina Regional Health Center designates its geographic service area as a 28-county region located in north central Kansas.  About 40 percent of Salina Regional Health Center’s patients come from outside of Saline County, helping the hospital to live up to the “region” in its name.  Through affiliations with clinics and medical facilities in Salina and the surrounding communities, Salina Regional Health Center works to provide excellent medical care to the region.

To learn more, visit: www.srhc.com

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